Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Curr Opin Urol. 2014 Mar;24(2):179-83. doi: 10.1097/MOU.0000000000000030.
The management of large intrarenal stones (>2 cm) is typically percutaneous nephrolithotomy. Although the stone-free rate (SFR) of such a procedure is high (up to 95%), the complications related mainly to the renal access are sometimes a concern. Because of the evolution in technology, it is nowadays possible to treat intrarenal stones with retrograde intrarenal surgery. It remains unclear weather or not retrograde intrarenal surgery (RIRS) may be effective also for the treatment of larger stones (>2 cm). The purpose of this review is to provide recent data on the ureteroscopic management of kidney stones larger than 2.5 cm.
A systematic review of the literature for studies identified between January 2000 and September 2013 was performed. Only English language articles reporting on more than 10 cases treated with RIRS for intrarenal stones larger than 2.5 cm were considered for this review.Particular emphasis was given to studies published within the last 12 months. Of the 324 studies identified, only 10 were considered suitable for this review. There were a total of 441 patients with a mean stone size of 2.9 cm. The SFR with an average of 1.6 procedures was 89.3%. The overall complication rate was 8% with major complication rate of 1.9%.
Although not supported by high evidence because of the absence of prospective randomized studies, it appears that in selected patients with large intrarenal stones, RIRS and laser lithotripsy may offer an acceptable efficacy with low morbidity.
对于>2cm 的大肾结石，通常采用经皮肾镜取石术（PCNL）治疗。尽管该手术的无石率（SFR）很高（高达 95%），但主要与肾通路相关的并发症有时令人担忧。由于技术的发展，目前可以采用逆行性肾内手术（RIRS）来治疗肾结石。对于>2cm 的肾结石，RIRS 是否有效尚不清楚。本文旨在提供最近有关输尿管镜治疗>2.5cm 肾结石的资料。
对 2000 年 1 月至 2013 年 9 月间发表的文献进行了系统回顾。只有报告采用 RIRS 治疗>2.5cm 肾结石的病例数>10 例且为英文文献的研究才被纳入本综述。特别关注了过去 12 个月内发表的研究。在 324 篇研究中，仅有 10 篇适合本综述。共有 441 例患者，平均结石大小为 2.9cm。平均 1.6 次手术的 SFR 为 89.3%。总的并发症发生率为 8%，主要并发症发生率为 1.9%。
虽然由于缺乏前瞻性随机研究，证据级别不高，但对于特定的大肾结石患者，RIRS 和激光碎石术似乎具有可接受的疗效和较低的发病率。
